Carpal Tunnel Syndrome: An Overview
by Mohammed AL-Issa, OMSII
Carpal tunnel syndrome refers to the compression of the median nerve, one of the major nerve that supplies the hand. Patients who have carpal tunnel syndrome experience weakness, pain, numbness and tingling in the hand and fingers. Like most medical conditions, if diagnosed early, carpal tunnel syndrome can be treated conservatively, but if left untreated for a long period of time, surgery might be required.
The Anatomy: There are 8 carpal bones, these are the wrist bones. These form the carpal tunnel. Structures that travel through the carpal tunnel are the median nerve, flexor pollicis longus tendon, 4 flexor digitorum superficialis tendons and 4 flexor digitorum profundus tendons. The floor of the carpal tunnel is formed by the carpal bones, and the roof is formed ligaments.
Carpal tunnel syndrome arises from compression to the median nerve. That happens when the flexor tendons swell, making the carpal tunnel narrower and putting pressure on the median nerve, that causes the weakness, pain and numbness that patients experience. As to why the flexor tendons swell, that can be caused by multiple things. The main factor is flexion or extension of the wrist for prolonged periods of time. This happens for people who sit on computes and type for prolonged periods of time. There is a genetic component to carpal tunnel syndrome in that some people have anatomically narrower carpal tunnels. Other disease can influence the onset of carpal tunnel syndrome like diabetes and rheumatoid arthritis.
How do you know you have carpal tunnel syndrome? Patients experience symptoms of pain, weakness and numbness in the hands and fingers at first. These sensations start gradually, and at first come and go. Patients often experience dropping things that they hold for prolonged periods of time. As the conditions progresses, the symptoms become more regular and last longer. Patients start experiencing pain at night time during sleep, some may experience pain that shoots up to the shoulder. Patients will often notice wasting of the thenar eminence (the group of muscles at the base of the thumb). Your doctor will perform certain tests like holding pressure on the wrist where the median nerve passes and see if that reproduces symptoms. Other tests include flexing the wrist and see if that reproduces symptoms, check thumb and finger strength, and look for wasting of the thenar eminence. Imaging testing might be needed in some cases.
You have carpal tunnel syndrome, now what? If caught early, carpal tunnel syndrome can be managed non-surgically by wearing a brace or a splint. At that point adjustment of hand activates might be required, including reducing the time at which the wrist is flexed or extended. Over the counter NSAIDS might help with inflammation and pain. In some cases, steroid injections might be used to relieve inflammation of the flexor tendons and help control reduce the pain.
If carpal tunnel has progressed long enough, surgery might be required. The surgery is an outpatient surgery, that can be done under general or local anesthesia. It can be done open hand or endoscopically. In either case, the surgeon goes in and divide the transverse carpal ligament that forms the roof of the carpal tunnel, that releases the pressure off the median nerve. Surgical outcomes are good for most patients, where they experience less pain and weakness. Recovery can be as quick as 3 months but could take up to a year.
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